What's the point of having medical insurance you can't use?

Question

I have Medicare & Medicaid, & I always have a hard time getting my prescriptions filled because Medicaid always tries to make Medicare pay for it, & then I have to pay out of pocket for them. Medicare alwways give me a hard time because they want Medicaid to pay for the prescriptions. & I have both & am eligible for both.

Does anyone else have this problem?

Answer 1

I think most people have that problem if they have more than one insurance. What you can do is get on the phone and determine if Medicare or Medicaid is your primary. Normally Medicare is the primary. The primary should pay first. If the primary does not cover the drug or if the entire amount of the drug is not covered then the secondary should pick up the rest.

Determine who is primary and that will give your pharmacy something to go on when they bill to get it covered. If you have the time, while you are standing there - if it is turned down - then call the customer service number and find out way. If it a drug that Medicare (or whomever is primary) does not cover then have the pharmacy run it through Medicaid. If Medicaid turns it down then call their customer service number and let them know Medicare did not cover it. Only get your prescriptions on days when you have time to do this. This will not have to be done everytime. Once they cover it once, it will be easier when getting refills.

If you take something on a regular basis and if Medicare is your primary then see about ordering it by mail. If you do that they will give you three months worth and it is easy to reorder.

In almost all cases Medicaid only covers what is not covered by other insurances. In Alaska (where I live), when I worked in a doctors office Medicaid told me that they are NEVER primary. I know that may not be the same in every state but it may be.

Answer 2

Depending upon your location there may be some Medicare Advantage plans available. Since you are on both Medicare and Medicaid you are considered "dual eligible". These plans have little or no premium and they provide all your health care, including the prescriptions. Also depending upon your state Medicaid will pay some if not all of the premium if there is one.

You'll want to visit a local independent agent that deals with senior policies (even if you aren't a senior these plans are available for you). Tell the agent you're dual eligible and they will be able to help you if a plan is available to you. If there isn't one this year there may be one next year so don't give up hope.

Answer 3

Well, the POINT is, free/cheap welfare health insurance.

See how well it works? That's about as well as socialized medicine will work, also. One government office fighting the other. Some things never change.

I DON'T have that problem, as I have private insurance. But I feel for ya - if you're on medicare & medicaid, it's because you aren't ABLE to get a private policy - which STINKS.

Answer 4

As a healthcare provider I can tell you that although this is a hassle for you....you are blessed beyond belief for the healthcare coverage you have. There are so many people who have no coverage at all....or have NO prescription coverage. So, I will not try to be mean, but.....see what someone without coverage, and working thier rear end off would say to you. I don't think you will be getting violin music...maybe some foul language though. I advise you to see the 'bigger picture'.

Answer 5

There is no point...it's just a money game

Answer 6

talk to your worker